Healthcare Provider Details

I. General information

NPI: 1275256034
Provider Name (Legal Business Name): DOMINIQUE HUNT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRACE RD STE H
CHERRY HILL NJ
08034-2600
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-547-0389
  • Fax: 856-325-4293
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00736800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: